=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265651491
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MANIPULATION & SPECIALTY HEALTHCARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2007
-----------------------------------------------------
Last Update Date | 05/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13809 S CASPER ST SUITE D
-----------------------------------------------------
City | GLENPOOL
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74033-2618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-291-0189
-----------------------------------------------------
Fax | 918-291-0190
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13809 S CASPER ST SUITE D
-----------------------------------------------------
City | GLENPOOL
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74033-2618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-291-0189
-----------------------------------------------------
Fax | 918-291-0190
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN OWNER
-----------------------------------------------------
Name | DR. CONSTANCE GILBERT HONEYCUTT
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 918-779-5907
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204D00000X
-----------------------------------------------------
Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
-----------------------------------------------------
License Number | 3069
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 3069
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------